Evidence map›Paper›PMID 42777587›Full record

ArticleJACC. Advances2026

Left Atrial Appendage Occlusion vs Direct Oral Anticoagulants for Atrial Fibrillation: Network Meta-Analyses.

Yuriko Hiruma, Tadao Aikawa, Iwanari Kawamura, Masao Iwagami, Polydoros Kampaktsis, Alexandros Briasoulis, Ali Fatehi Hassanabad, Kaveh Hosseini, Pier Pasquale Leone, Leandro Slipczuk and 4 more

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in JACC. Advances, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

14 authors.

Yuriko HirumaDivision of Internal Medicine, North Alabama Medical Center, Florence, Alabama, USA.
Tadao AikawaDepartment of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan.
Iwanari KawamuraDepartment of Cardiovascular Medicine, Institute of Science Tokyo, Tokyo, Japan.
Masao IwagamiDepartment of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom; Department of Digital Health, Institute of Medicine, University of Tsukuba, Tsukuba, Japan.
Polydoros KampaktsisStructural and Congenital Center, Hackensack Medical Center, Hackensack, New Jersey, USA.
Alexandros BriasoulisDivision of Cardiovascular Medicine, Section of Heart Failure and Transplantation, University of Iowa, Iowa City, Iowa, USA.
Ali Fatehi HassanabadSection of Cardiac Surgery, University of Calgary, Calgary, Alberta, Canada.
Kaveh HosseiniCardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran; Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark; Center for Translational Cardiology and Pragmatic Randomized Trials, Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
Pier Pasquale LeoneDivision of Cardiology, Montefiore Health System/Albert Einstein College of Medicine, Bronx, New York, USA.
Leandro SlipczukDivision of Cardiology, Montefiore Health System/Albert Einstein College of Medicine, Bronx, New York, USA.
Jose WileySection of Cardiology, Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana, USA.
Eric SecemskyRichard A and Susan F Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA; Division of Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
Roger LahamDivision of Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
Toshiki KunoRichard A and Susan F Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA; Institute of Medicine, University of Tsukuba, Tsukuba, Japan; Division of Cardiovascular Medicine, Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon, USA. Electronic address: kuno-toshiki@hotmail.co.jp.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundLeft atrial appendage occlusion (LAAO) is a treatment option to prevent thromboembolic events in patients with atrial fibrillation. However, it remains unclear whether LAAO offers superior efficacy and safety compared with oral anticoagulation for these patients.

objectivesThis study aimed to assess the efficacy and safety of LAAO vs direct oral anticoagulants (DOACs).

methodsWe reviewed randomized controlled trials comparing oral anticoagulation and LAAO, using MEDLINE and CENTRAL. The primary outcome was a composite of stroke, systemic embolism, and cardiovascular death, whereas the safety outcome was major bleeding. Two network meta-analyses were conducted to assess LAAO vs DOAC, incorporating indirect comparisons: 1 comparing LAAO, DOACs, and vitamin K antagonist (3 arms), and the other comparing Watchman, Amulet, DOACs, and vitamin K antagonist (4 arms).

resultsA total of 67,693 patients from 11 randomized controlled trials were included, of whom 5,735 underwent LAAO. In the three-arm network meta-analysis, LAAO and DOACs demonstrated statistically similar risks for both the primary efficacy outcome (HR: 1.02; 95% CI: 0.88-1.19; I

conclusionsLAAO devices did not demonstrate statistical superiority over DOACs in reducing thromboembolic events and major bleeding. Further trials are warranted to define patients for whom LAAO may offer the most significant benefit, such as those with high bleeding risk (CRD420251237886).

Indexed as

amuletatrial fibrillationdirect oral anticoagulantleft atrial appendage occlusionWatchman

Identifiers

PMID42777587
PMCPMC13634779

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.